In June of 2016, the Commonwealth of Pennsylvania released the Health Innovation in Pennsylvania Plan (HIP), which outlined the state’s initiative to accelerate the transformation of health care delivery. One of the initiative’s primary focuses is the redesign of rural healthcare delivery.

The HIP plan highlights the current costs of healthcare in Pennsylvania:

• The total healthcare spending for all coverage types and services is higher than the national average by 13.4 percent.
• Medicaid spending accounts for approximately 30 percent of the total budget.
• Medicaid spent 36 percent more on older adults, and overuse of medical care for high-cost, high-need patients account for 50 percent of patient costs that result from 5 percent of the population.

These healthcare spending challenges that Pennsylvania faces today are not much different than the ones the State faced almost 14 years ago.

A smartphone solution

In 2003, Dr. Gerard Criner at Temple University Hospital received a grant from the Pennsylvania Department of Health to help determine why urban and rural residents of Pennsylvania might be at higher risk for deadly, debilitating and costly hospitalizations for chronic obstructive pulmonary disease (COPD).

COPD is the third-leading cause of death in the United States and affects 6.1 percent of the population in Pennsylvania. He hypothesized that repeat acute exacerbations of COPD in high-risk patients can be reduced with a simple remote intervention via the use of a smartphone.

Here’s how it worked: The patients in the interventional group would answer five to seven questions daily. Then, depending on their answers, the study nurse would call the patient to deliver appropriate care based on study physician feedback. Patients in the control group would answer the five to seven questions without call center intervention, regardless of their answers.

At the conclusion of the study in 2008, Dr. Criner and his team found that patients in the interventional group received earlier treatment of symptoms and had greater improvement in lung function and functional status, compared to the control arm.

The startup grows

After this seminal study (PA-SCOPE) and two smaller scale follow-up studies using the core technology, Temple University spun out the technology from the studies into a disease management company called HGE Health Care Solutions.

After the formation of the company, HGE was granted a contract by Temple to manage at-risk Medicare/Medicaid patients to help improve patient outcomes. After ramping up enrollment and seeing positive results in just 6 months, HGE was awarded a contract by a local insurer to help manage more patients. Results from the additional patients saw a 60 percent reduction in utilization (ER visits, inpatient admissions, inpatient days and readmissions) and a 65 percent decrease in length of stay for patients admitted for an acute exacerbation of COPD.

In addition to our disease management duties at HGE, we’ve expanded the business by becoming an approved vendor for clinical trials. This means that we create new products to be used in clinical trials for disease data collection.

Our disease management and data collection platforms have given us the opportunity to grow in two distinct areas of the healthcare business. Since the inception of the company, we have increased our enrollment for disease management to over 1,200 patients and have taken on five clinical trials for data collection.

Our expanding role in both telemedicine/disease management and clinical trials since incorporating in 2012 has allowed our company to grow from five employees to 35.

What we’ve learned

We have built great technology at HGE, but the real driver of our results is our people providing the service. A lot goes into a telemedicine program than just technology. Our high level of patient engagement (over 90 percent of patients are engaged on a daily basis) stems from our high level of patient interaction.

We believe that the service we provide is what separates us from other telemedicine companies by having an open daily exchange and empathy for our patients that are our keys to delivering optimum outcomes. Our employees and the service we provide to our patients are the engine that makes our company go — the software is just a vehicle for efficient and proactive care.

Since the incorporation of HGE, we’ve realized that even in the advent of the connected age, the healthcare industry still has a lot of catching up to do. As technology has improved and the barrier to owning a smartphone has drastically decreased since 2012, telemedicine and its incorporation into the healthcare field as a means for disease management and the associated billing for it are close to nonexistent.

Hopefully, with more research grants and initiatives funded by the State and Federal government, we will see new technologies and further advancement of telemedicine. Until then, HGE will continue to be a pioneer on the frontlines of telemedicine-based disease management programs for chronic lung diseases.

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